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Mapping Pathways is a multi-national project to develop and nurture a research-driven, community-led global understanding of the emerging evidence base around the adoption of antiretroviral-based prevention strategies to end the HIV/AIDS epidemic. The evidence base is more than results from clinical trials - it must include stakeholder and community perspectives as well.

05 December 2011

Pleasure Matters for Females Too!

"Female students placed a premium on the pursuit of pleasurable sex in and of itself. This was especially evident in the manner that they spoke about their sexual experiences. One student made it clear that she, and not her boyfriend, had initiated many of their sexual encounters, while another student matter-of-factly explained that condoms interfered with her full enjoyment of the sexual act: ‘Condoms are too clinical! I know that there isn’t much of a difference between sex with a condom and without, but I like to know that it’s just me to him, not me to him through some plastic!’"

"The absence of recent research on ‘the joys of sex’ - with the exception of Sylvia Tamale's African Sexualities Reader - reflects societies’ general discomfiture with young women’s sexual desire and sexual freedom more than it does the actual absence of the phenomena. Indeed the observation by sexologists Gagnon and Simon that ‘the idea of female sexual freedom is intolerable in most societies’ holds true today in many parts of the world, including Africa, as it did of nineteenth century America that they were writing about. Therefore, as we work towards making this years World AIDS Day theme of ‘Getting to Zero’ a reality, HIV interventions will need to be bolder and seriously take into account young African women’s actual sexual experiences and their lived sexual realities, however unsettling these may be for us in the HIV prevention community."

During fieldwork for my doctoral thesis in anthropology in 2007 I recall a female student at a university in Zimbabwe’s capital Harare saying to me, ‘Girls should stop acting as if they don’t like sex…from what I have seen from girls here on campus, they look forward to that [sic] more than guys do’. This statement caught me off-guard, not only because of the contempt with which it was uttered, but also because it was made by a young, unmarried African woman, in the presence of her best friend (another young unmarried woman) and was addressed to me, a virtual stranger. This was my second meeting with the two female students and already, both had stunned me with their frankness around sexual issues and especially around their own sexual experiences. In earlier discussions the two students had been quite vocal on the issue of sex and, in response to a question I had asked, one of them had declared that she never had reason to turn down her boyfriend’s sexual advances: ‘If he asks for sex, I give him. Why not? It’s not like girls don’t enjoy sex. They do!’

I was conducting ethnographic research on the relationship between ‘campus sexual cultures’ and female and male students’ HIV risk-taking behaviour and I found this openness by young Zimbabwean women both intriguing and refreshing. It is rare to read about young, heterosexual African women’s positive and pleasurable pre-marital sexual experiences. Often, the policy and academic literature portrays African women in one of two ways: as sexually passive and unwilling participants in the sexual act, or as sexually ‘immoral’ and ‘loose’ if they show any interest in sex at all. Neither of these portrayals fully capture the totality of young, unmarried African women’s lived realities. The views and experiences of the young women I encountered during fieldwork challenge these stereotypical portrayals, and suggest that in reality sex is not always something that is ‘done’ to young women. Neither are young women always passive and reluctant participants in sexual encounters. Feminist scholar Carole Vance, who championed a mini-revolution around women’s sexual pleasure in the US in the late eighties, poignantly observed that ‘danger and pleasure are ever-present realities in many women’s lives’. She further argued that focusing wholly on pleasure or danger oversimplifies women’s actual sexual experiences, which, in reality, are more complicated and unsettling. Dichotomies, as we very well know, are problematic in that one can only ever be one or the other— never both, and certainly never something else entirely.

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The evidence base is more than P-values and confidence intervals

There is a clear and pressing need to engage policymakers and community stakeholders in the consideration of treatment and prevention options for HIV/AIDS.

This necessity has grown stronger in light of current research showing extraordinary promise of using antiretroviral (ARV) therapies for the prevention of HIV. These ARV-based strategies include a ‘treatment as prevention’ model known as TLC+ (testing, linkage to care, plus treatment) as well as vaginal and rectal microbicides and pre-exposure prophylaxis (PrEP).

Mapping Pathways includes a thorough review of the social, economic and clinical impacts of treatment as prevention and TLC+, as well as microbicides, PrEP, and post-exposure prophylaxis, in the contexts of South Africa, India and the United States. Participation and engagement is at the heart of the study, and stakeholder input across the community, research, policy and governmental spheres will be a core focus in all three countries.

The project’s aim is to provide the research and analysis that communities and policymakers need in order to formulate coherent, evidence-based decisions for HIV/AIDS treatment and prevention strategies in the 21st century.

Mapping Pathways firmly believes that the evidence base is comprised of more than scientific data derived from clinical research – it is more than P-values and confidence intervals. The perspectives, experiences, and collective wisdom of community members and key stakeholders must be valued as much as statistically significant trial results.